tbuckley/cabot-search huggingface dataset:
England’s food strategy: local directors of public health need to be given power and resources
Authors: Michael Craig Watson, John Lloyd
Journal: BMJ (2022)

<h3>ABSTRACT</h3> <h3>Objective:</h3> Degenerative ataxias in children present a rare condition where effective treatments are lacking. Intensive coordinative training based on physiotherapeutic exercises improves degenerative ataxia in adults, but such exercises have drawbacks for children, often including a lack of motivation for high-frequent physiotherapy. Recently developed whole-body controlled video game technology might present a novel treatment strategy for highly interactive and motivational coordinative training for children with degenerative ataxias. <h3>Methods:</h3> We examined the effectiveness of an 8-week coordinative training for 10 children with progressive spinocerebellar ataxia. Training was based on 3 Microsoft Xbox Kinect video games particularly suitable to exercise whole-body coordination and dynamic balance. Training was started with a laboratory-based 2-week training phase and followed by 6 weeks training in children’s home environment. Rater-blinded assessments were performed 2 weeks before laboratory-based training, immediately prior to and after the laboratory-based training period, as well as after home training. These assessments allowed for an intraindividual control design, where performance changes with and without training were compared. <h3>Results:</h3> Ataxia symptoms were significantly reduced (decrease in Scale for the Assessment and Rating of Ataxia score, <i>p</i> = 0.0078) and balance capacities improved (dynamic gait index, <i>p</i> = 0.04) after intervention. Quantitative movement analysis revealed improvements in gait (lateral sway: <i>p</i> = 0.01; step length variability: <i>p</i> = 0.01) and in goal-directed leg placement (<i>p</i> = 0.03). <h3>Conclusions:</h3> Despite progressive cerebellar degeneration, children are able to improve motor performance by intensive coordination training. Directed training of whole-body controlled video games might present a highly motivational, cost-efficient, and home-based rehabilitation strategy to train dynamic balance and interaction with dynamic environments in a large variety of young-onset neurologic conditions. <h3>Classification of evidence:</h3> This study provides Class III evidence that directed training with Xbox Kinect video games can improve several signs of ataxia in adolescents with progressive ataxia as measured by SARA score, Dynamic Gait Index, and Activity-specific Balance Confidence Scale at 8 weeks of training.
Death, futility, and oncology
Authors: Santhanam Sundar
Journal: BMJ (2022)

<h3>SUMMARY</h3> Hypoglycemia is a clinical hallmark of severe malaria, the often-lethal presentation of <i>Plasmodium falciparum</i> infection of humans. Here we report that mice reduce blood glucose levels in response to <i>Plasmodium</i> infection via a coordinated response whereby labile heme, an alarmin produced via hemolysis, induces anorexia and represses hepatic glucose production (HGP). While protective against unfettered immune-mediated inflammation, organ damage and anemia, when sustained over time heme-driven repression of HGP can progress towards hypoglycemia, compromising host energy expenditure and thermoregulation. This hypometabolic state arrests the development of asexual stages of <i>Plasmodium spp</i>., which undergo pyknosis and develop mitochondrial dysfunction. In response, <i>Plasmodium</i> activates a transcriptional program reducing its virulence and inducing sexual differentiation towards the production of transmissible gametocytes. We infer that malaria-associated hypoglycemia represents a trade-off of an evolutionarily conserved defense strategy restricting <i>Plasmodium spp</i>. from accessing host-derived glucose and balancing parasite virulence and transmission.
Author Correction: Effect of host genetics on the gut microbiome in 7,738 participants of the Dutch Microbiome Project
Authors: Esteban A. Lopera-Maya, Alexander Kurilshikov, Adriaan van der Graaf, Shixian Hu, Sergio Andreu-Sánchez, Lianmin Chen, Arnau Vich Vila, Ranko Gacesa, Trishla Sinha, Valerie Collij, Marjiolein A. Y. Klaassen, Laura A. Bolte, Milla F. Brandao Gois, Pieter B. T. Neerincx, Morris A. Swertz, Raul Aguirre-Gamboa, Patrick Deelen, Lude Franke, Jan A. Kuivenhoven, Esteban A. Lopera-Maya, Ilja M. Nolte, Serena Sanna, Harold Snieder, Morris A. Swertz, Judith M. Vonk, Cisca Wijmenga, Hermie J. M. Harmsen, Cisca Wijmenga, Jingyuan Fu, Rinse K. Weersma, Alexandra Zhernakova, Serena Sanna
Journal: Nature Genetics (2022)
Unrelated Allogeneic Stem Cell Transplant in Relapsed/Refractory AML: Widening the Yellow Brick Road
Authors: Diego A. Adrianzen-Herrera, Aditi Shastri
Journal: Clinical Cancer Research (2022)

Summary A sizable proportion of patients with acute myeloid leukemia (AML) fail to achieve remission. Hematopoietic stem cell transplantation (HSCT) is the only intervention with potential of long-term survival. A recent Acute Leukemia Working Party (ALWP)/European Society for Blood and Marrow Transplantation (EBMT) analysis reports substantial posttransplant survival gains for patients with active disease who received transplants. Decreased relapse was the largest contributor to survival, a cause for optimism in this challenging population. See related article by Nagler et al., p. 4258
Corrigendum to: TERT promoter C228T mutation in neural progenitors confers growth advantage following telomere shortening in vivo
Journal: Neuro-Oncology (2022)

Additional criteria apply.Please refer to protocol 14379-201 for full inclusion and exclusion criteria.† Patients can participate if they had some skin cancers, superficial bladder cancer (cancer that was only on the surface of the lining of the bladder), or carcinoma in situ (cancer that had not spread) of the cervix or breast that had been cured.HIV, human immunodeficiency virus; HBV, hepatitis B virus; HCV, hepatitis C virus; IGF-1R, insulin-like growth factor 1 receptor; KPS, Karnofsky Performance Scale; RT, radiotherapy; SOC, standard of care; TMZ, temozolomide.
Consistent Effects of Hypoglycemia on Cognitive Function in People With or Without Diabetes
Authors: Clementine E.M. Verhulst, Therese W. Fabricius, Giesje Nefs, Roy P.C. Kessels, Frans Pouwer, Steven Teerenstra, Cees J. Tack, Melanie M. Broadley, Peter L. Kristensen, Rory J. McCrimmon, Simon Heller, Mark L. Evans, Ulrik Pedersen-Bjergaard, Bastiaan E. de Galan
Journal: Diabetes Care (2022)

OBJECTIVE Hypoglycemia poses an immediate threat for cognitive function. Due to its association with acute cognitive impairment, the International Hypoglycemia Study Group (IHSG) defines a blood glucose level &amp;lt;3.0 mmol/L as “level 2 hypoglycemia.” In the current study we investigated whether having diabetes, type of diabetes, or hypoglycemia awareness moderates this association. RESEARCH DESIGN AND METHODS Adults with type 1 diabetes with normal (n = 26) or impaired (n = 21) hypoglycemic awareness or with insulin-treated type 2 diabetes (n = 15) and age-matched control subjects without diabetes (n = 32) underwent a hyperinsulinemic-euglycemic-hypoglycemic glucose clamp (2.80 ± 0.13 mmol/L [50.2 ± 2.3 mg/dL]). At baseline and during hypoglycemia, calculation ability, attention, working memory and cognitive flexibility were measured with the Paced Auditory Serial Addition Test (PASAT) and the Test of Attentional Performance (TAP). RESULTS For the whole group, hypoglycemia decreased the mean ± SD proportion of correct answers on the PASAT by 8.4 ± 12.8%, increased reaction time on the TAP Alertness task by 32.1 ± 66.6 ms, and increased the sum of errors and omissions on the TAP Working Memory task by 2.0 ± 5.5 (all P &amp;lt; 0.001). Hypoglycemia-induced cognitive declines were largely irrespective of the presence or type of diabetes, level of symptomatic awareness, diabetes duration, or HbA1c. CONCLUSIONS IHSG level 2 hypoglycemia impairs cognitive function in people with and without diabetes, irrespective of type of diabetes or hypoglycemia awareness status. These findings support the cutoff value of hypoglycemia &amp;lt;3.0 mmol/L (&amp;lt;54 mg/dL) as being clinically relevant for most people with diabetes.
Twenty-Year Temporal Trends in Risk of Ischemic Stroke in Incident Type 2 Diabetes: A Danish Population-Based Cohort Study
Authors: Christine Gyldenkerne, Johnny Kahlert, Kevin K.W. Olesen, Pernille G. Thrane, Henrik T. Sørensen, Reimar W. Thomsen, Michael Maeng
Journal: Diabetes Care (2022)

OBJECTIVE We examined temporal trends in risk of first-time ischemic stroke in patients with incident type 2 diabetes mellitus (T2DM) and no prior atherosclerotic cardiovascular disease (ASCVD). RESEARCH DESIGN AND METHODS Using nationwide health registries, we identified all patients with incident T2DM without a prior hospital diagnosis of ASCVD from 1996 to 2015 in Denmark. Patients were assigned to 5-year periods based on the date of T2DM diagnosis and were followed for 5 years. Each patient was matched by sex and age with up to three individuals from the general population. Temporal trends in ischemic stroke were examined using Cox regression to compute hazard ratios (HRs). Temporal use of prophylactic cardiovascular medications was also assessed. RESULTS The study comprised 288,825 patients with incident T2DM and 782,232 general population individuals. From 1996–2000 to 2011–2015, the 5-year risk of first-time ischemic stroke was approximately halved in the T2DM cohort (5.2% vs. 2.7%; sex- and age-adjusted HR 0.52 [95% CI 0.49–0.55]). Patients diagnosed in 2011–2015 had increased risk of ischemic stroke compared with individuals in the general population; however, the risk difference narrowed over time (5.2% vs. 2.9% in 1996–1999 [difference 2.3%]; 2.7% vs. 2.0% in 2011–2015 [difference 0.7%]). Use of prophylactic cardiovascular medications increased markedly during the overall study period, especially use of statins (from 5% to 50%) and multiple antihypertensive drugs (from 18% to 33%). CONCLUSIONS From 1996 to 2015, the 5-year risk of first-time ischemic stroke was approximately halved in patients with incident T2DM and no prior ASCVD, coinciding with markedly increased use of prophylactic cardiovascular medications.
Highlights from this issue
Journal: Thorax (2022)

make way for Professors Griffiths, O'Kane and Quint, we have reflected on the front covers that demonstrated our ambition of embedding originality, rigour and excellence across paediatric and adult research in respiratory, sleep and critical care medicine.If only we could have considered this maxim more deeply when we were writing Airwaves each month.We hope you enjoyed reading Airwaves significantly more than we enjoyed writing it.This month's Airwaves moves from first to last, art to science, frivolity to the important, collaboration to interdependence and some unusual and surprising.The Triumvirate had become addicted to the continuous improvement of Thorax and now it's time for them to rest and get into rehab.
Health Care Experiences of Patients Discontinuing or Reversing Prior Gender-Affirming Treatments
Authors: Kinnon R. MacKinnon, Hannah Kia, Travis Salway, Florence Ashley, Ashley Lacombe-Duncan, Alex Abramovich, Gabriel Enxuga, Lori E. Ross
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Medical education, research, and clinical guidelines are available to support the initiation of gender-affirming care for transgender and nonbinary people. By contrast, little is known about the clinical experiences of those who discontinue or seek to reverse gender-affirming medical or surgical interventions due to a change in gender identity, often referred to as<i>detransition</i>. <h3>Objective</h3> To examine the physical and mental health experiences of people who initiated medical or surgical detransition to inform clinical practice. <h3>Design, Setting, and Participants</h3> Using constructivist grounded theory as a qualitative approach, data were collected in the form of in-depth interviews. Data were analyzed using an inductive 2-stage coding process to categorize and interpret detransition-related health care experiences to inform clinical practice. Between October 2021 and January 2022, individuals living in Canada who were aged 18 years and older with experience of stopping, shifting, or reversing a gender transition were invited to partake in semistructured virtual interviews. Study advertisements were circulated over social media, to clinicians, and within participants' social networks. A purposive sample of 28 participants who discontinued, shifted, or reversed a gender transition were interviewed. <h3>Main Outcomes and Measures</h3> In-depth, narrative descriptions of the physical and mental health experiences of people who discontinued or sought to reverse prior gender-affirming medical and/or surgical interventions. <h3>Results</h3> Among the 28 participants, 18 (64%) were assigned female at birth and 10 (36%) were assigned male at birth; 2 (7%) identified as Jewish and White, 5 (18%) identified as having mixed race and ethnicity (which included Arab, Black, Indigenous, Latinx, and South Asian), and 21 (75%) identified as White. Participants initially sought gender-affirmation at a wide range of ages (15 [56%] were between ages 18 and 24 years). Detransition occurred for various reasons, such as an evolving understanding of gender identity or health concerns. Participants reported divergent perspectives about their past gender-affirming medical or surgical treatments. Some participants felt regrets, but a majority were pleased with the results of gender-affirming medical or surgical treatments. Medical detransition was often experienced as physically and psychologically challenging, yet health care avoidance was common. Participants described experiencing stigma and interacting with clinicians who were unprepared to meet their detransition-related medical needs. <h3>Conclusions and Relevance</h3> This study's results suggest that further research and clinical guidance is required to address the unmet needs of this population who discontinue or seek to reverse prior gender-affirming interventions.
Journal club
Authors: Matthew Steward
Journal: Thorax (2022)

FIBROSIS (IPF): ENHANCES PROGNOSTICATION ACCURACYIPF is a clinically and radiologically heterogenous condition.AIQCT is a novel tool developed, in part, to account for the interobserver variability seen when reporting parenchymal abnormalities on CT in IPF.Handa et al (Ann Am Thorac Soc 2022;19:399) used AIQCT in a training cohort of 304 CTs from patients with IPF to derive prognostic features, and then applied to 120 consecutively enrolled patients in a validation cohort.Patients required paired pulmonary function tests within 3 months of scanning, and scans could not demonstrate pleural effusion, pneumomediastinum or acute exacerbation of IPF (AE-IPF).Correlation coefficients outperformed those of texture-based analysis methods (p≤0.001 for 7/9 radiographic patterns), such as Canadian Laboratory Initiative on Paediatric Intervals, and reflects the reliability of AIQCT for quantification of lung abnormalities seen in other studies of the modality.Strengths of this protocol include the ability to differentiate traction bronchodilatation from honeycombing, and the automatic volumetric measurement of airways to include peripheral airways.AIQCT not only reliably identifies lung parenchymal patterns but also bronchial and central airways volumes.Multivariate Cox regression analysis including gender-age physiology staging found that bronchial volume (ie, the presence of traction bronchodilatation) and normal (non-interstitial lung disease (ILD)) lung volumes were independent prognostic factors in IPF (HRs 1.33, 95% CI 1.16 to 1.53, and 0.97, 95% CI 0.94 to 0.99, respectively).This study demonstrates the potential for novel software to enhance clinical care by providing better information to clinicians on longer-term outcomes but it requires further research prior to adoption into clinical practice.
Effect of a Comprehensive Telehealth Intervention vs Telemonitoring and Care Coordination in Patients With Persistently Poor Type 2 Diabetes Control
Authors: Matthew J. Crowley, Phillip E. Tarkington, Hayden B. Bosworth, Amy S. Jeffreys, Cynthia J. Coffman, Matthew L. Maciejewski, Karen Steinhauser, Valerie A. Smith, Moahad S. Dar, Sonja K. Fredrickson, Amy C. Mundy, Elizabeth M. Strawbridge, Teresa J. Marcano, Donna L. Overby, Nadya T. Majette Elliott, Susanne Danus, David Edelman
Journal: JAMA Internal Medicine (2022)

Persistently poorly controlled type 2 diabetes (PPDM) is common and causes poor outcomes. Comprehensive telehealth interventions could help address PPDM, but effectiveness is uncertain, and barriers impede use in clinical practice.
Aspirin for the Primary Prevention of Atherosclerotic Cardiovascular Disease in Women
Authors: Chrisandra L. Shufelt, Samia Mora, JoAnn E. Manson
Journal: JAMA (2022)

This JAMA Insights Clinical Update discusses updated recommendations on the use of aspirin for primary prevention of atherosclerotic cardiovascular disease in women and stresses the importance of shared clinical decision-making.
The Gift
Authors: Ramya Sampath
Journal: JAMA Internal Medicine (2022)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
An Electronic Medical Record–Based Decision Support Tool for the Diagnosis of Primary Hyperparathyroidism
Authors: Nardeen B. Dawood, Michelle L. Shu, Chi-Hong Tseng, Jiyoon Kim, Dalena T. Nguyen, Angela M. Leung, Michael W. Yeh
Journal: JAMA Internal Medicine (2022)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2022 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Clinico-Genomic Characterization of Patients with Metastatic Urothelial Carcinoma in Real-World Practice Identifies a Novel Bladder Immune Performance Index (BIPI)
Authors: Bernadett Szabados, Mariano Ponz-Sarvisé, Robson Machado, Diego Saldana, Edward E. Kadel, Romain Banchereau, Fanny Bouquet, Marius Garmhausen, Thomas Powles, Carsten Schröder
Journal: Clinical Cancer Research (2022)

Abstract Purpose: This retrospective analysis of the largest available clinico-genomic database used de-identified patient-level electronic health record–derived real-world data (RWD) combined with FoundationOne comprehensive genomic profiling (CGP) to characterize patients with metastatic urothelial carcinoma (mUC) treated in the real-world setting, detect potential biomarkers, and develop a bladder immune performance index (BIPI). Experimental Design: Patients with mUC who started front-line single-agent immune checkpoint inhibitors (ICI) and an unmatched group treated with front-line platinum-based chemotherapy between January 1, 2011, and September 30, 2019, were selected. Clinical and genomic data were correlated with overall survival (OS). A novel BIPI predicting outcome with ICIs was developed using machine learning methods and validated using data from a phase II trial (NCT02951767). Results: In ICI-treated patients (n = 118), high tumor mutational burden (≥10 mutations/megabase) was associated with improved OS (HR, 0.58; 95% CI, 0.35–0.95; P = 0.03). In chemotherapy-treated patients (n = 268), those with high APOBEC mutational signature had worse OS (HR, 1.43; 95% CI, 1.06–1.94; P = 0.02). Neither FGFR3 mutations nor DNA damage–repair pathway alterations were associated with OS. A novel BIPI combining clinical and genomic variables (nonmetastatic at initial diagnosis, normal or above normal albumin level at baseline, prior surgery for organ-confined disease, high tumor mutational burden) identified ICI-treated patients with longest OS and was validated in an independent dataset. Conclusions: Contemporary RWD including FoundationOne CGP can be used to characterize outcomes in real-world patients according to biomarkers beyond PD-L1. A validated, novel clinico-genomic BIPI demonstrated satisfactory prognostic performance for OS in patients with mUC receiving front-line ICI therapy.
Understanding and Supporting Patients With Dynamic Desires for Gender-Affirming Medical Interventions
Authors: Jack L. Turban, Christine Brady, Johanna Olson-Kennedy
Journal: JAMA Network Open (2022)

Kinnon R. MacKinnon, PhD; Hannah Kia, PhD; Travis Salway, PhD; Florence Ashley, LLM (bioeth); Ashley Lacombe-Duncan, PhD; Alex Abramovich, PhD; Gabriel Enxuga, BSW; Lori E. Ross, PhD
Spotting Spodick Sign in the Diagnostic Dilemma—Reply
Authors: Mochamad Yusuf Alsagaff, Terrence Timothy Evan Lusida, Yusuf Azmi
Journal: JAMA Internal Medicine (2022)

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Financial Hardship in Cancer Care—The Need to Define and Intervene on Actionable Metrics
Authors: Edward Christopher Dee, Fumiko Chino
Journal: JAMA Network Open (2022)

Nandita Khera, MD, MPH; Nan Zhang, MS; Talal Hilal, MD; Urshila Durani, MD; Minji Lee, PhD, MS; Rema Padman, PhD; Sandeep Voleti, BS; Rahma M. Warsame, MD; Bijan J. Borah, PhD; K. Robin Yabroff, PhD; Joan M. Griffin, PhD